Two studies published by the National Institutes of Health show promising results for the use of simulators in the training of emergency physicians (EP) in performing transesophageal echocardiography (TEE). In the study “Focused transesophageal echocardiography for emergency physicians—description and results from simulation training of a structured four-view examination”, a post-workshop survey of a convenience sample of 14 EPs revealed that all study participants were “satisfied” or “extremely satisfied” with the educational session. 12 of the EPs (85.7 %) participants reported feeling confident in their ability to use the training to acquire clinically acceptable TEE views in vivo.
In the study “Emergency Physician-performed Transesophageal Echocardiography in Simulated Cardiac Arrest”, 40 emergency medicine residents (EM) with varying levels of echocardiography experience completed four weekly sessions, three for training and one for testing. The EM residents were able to acquire two standard TEE views and diagnose common conditions in simulated cardiac arrests with a high degree of sensitivity, specificity, and reliability.
When caring for critically ill patients with acute circulatory failure or cardiac arrest, EPs often use transthoracic echocardiography (TTE) to assist in diagnosis, therapy, and prognosis. TTE applications include assessment for hemodynamically significant pericardial effusion,1-3 determining prognosis in the setting of cardiac arrest,4-6 and assessing gross left ventricular (LV) function.7-9 Unfortunately, acquisition of adequate TTE images is less than ideal because of interference from the lungs, mechanical ventilation, surgical dressings, or patient body habitus.10-11
On the other hand, TEE has advantages over TTE. TEE can reliably obtain high-quality images because of the probe’s indwelling esophageal location, placed millimeters behind the heart. This difference in acquisition and image quality results in superior success rates (97% for TEE and 38% for TTE) in answering clinical questions.11 TEE also has a unique role in cardiac arrest resuscitation with its ability to investigate the heart without interrupting chest compressions.12-15 Yet even with TEE’s advantages, TTE remains the most commonly used method to image the heart. Given the evidence of superior performance of TEE-compatible portable ultrasound machines and realistic training simulators, healthcare institutions should consider leveraging realistic simulators to advance the use of TEE.
To promote the use of TEE simulators for EPs, FUJIFILM Sonosite has partnered with Intelligent Ultrasound Group, the makers of BodyWorks Eve, an ultra-realistic patient simulator designed for interactive POCUS scenario training. The ultimate goal of the partnership is to help improve the POCUS user’s clinical knowledge and diagnostic confidence.
BodyWorks Eve comes with 100 real patient scans and over 10,000 pathology variations across cardiac, lung, transabdominal, and pelvic ultrasound. Eve can help Sonosite’s POCUS users train for diverse scenarios in emergency and critical medicine. Eve focuses on the recognition of common abnormalities and pathology, assessment skills to guide decisions for patient referral or discharge, Doppler and M-mode functions, and more.
In addition, the partnership includes Intelligent Ultrasound Group’s HeartWorks® TEE simulator, which helps POCUS users to develop the required cognitive and psychomotor skills for TEE. The TEE Simulator helps students learn cardiac anatomy, practice TEE probe manipulation, acquire quality diagnostic images, along with leveraging 2-D, Doppler, and M-Mode functions.
Read More about Using Simulators to Teach TEE
Emergency Physician-performed Transesophageal Echocardiography in Simulated Cardiac Arrest
References
1Plummer D, Brunette D, Asinger R, et al. Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann Emerg Med. 1992;21(6):709–712. doi: 10.1016/S0196-0644(05)82784-2. [PubMed] [CrossRef] [Google Scholar]
2Mayron R, Gaudio F, Plummer D, et al. Echocardiography performed by emergency physicians: impact on diagnosis and therapy. Ann Emerg Med. 1988;17(2):150–154. doi: 10.1016/S0196-0644(88)80301-9. [PubMed] [CrossRef] [Google Scholar]
3Tayal V, Kline J. Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states. Resuscitation. 2003;59(3):315–318. doi: 10.1016/S0300-9572(03)00245-4. [PubMed] [CrossRef] [Google Scholar]
4Blaivas M, Fox J. Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram. Acad Emerg Med. 2001;8(6):616–621. doi: 10.1111/j.1553-2712.2001.tb00174.x. [PubMed] [CrossRef] [Google Scholar]
5Salen P, Melniker L, Chooljian C, et al. Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients? The Am J Emerg Med. 2005;23(4):459–462. doi: 10.1016/j.ajem.2004.11.007. [PubMed] [CrossRef] [Google Scholar]
6Salen P, O’Connor R, Sierzenski P, et al. Can cardiac sonography and capnography be used independently and in combination to predict resuscitation outcomes? Acad Emerg Med. 2001;8(6):610–615. doi: 10.1111/j.1553-2712.2001.tb00172.x. [PubMed] [CrossRef] [Google Scholar]
7Moore C, Rose G, Tayal V, et al. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med. 2002;9(3):186–193. doi: 10.1111/j.1553-2712.2002.tb00242.x. [PubMed] [CrossRef] [Google Scholar]
8Randazzo M, Snoey E, Levitt M, et al. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med. 2003;10(9):973–977. doi: 10.1111/j.1553-2712.2003.tb00654.x. [PubMed] [CrossRef] [Google Scholar]
9Melamed R, Sprenkle M, Ulstad V, et al. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest. 2009;135(6):1416–1420. doi: 10.1378/chest.08-2440. [PubMed] [CrossRef] [Google Scholar]
10Parker M, Cunnion R, Parrillo J. Echocardiography and nuclear cardiac imaging in the critical care unit. JAMA. 1985;254(20):2935–2939. doi: 10.1001/jama.1985.03360200087035. [PubMed] [CrossRef] [Google Scholar]
11Vignon P, Mentec H, Terré S, et al. Diagnostic accuracy and therapeutic impact of transthoracic and transesophageal echocardiography in mechanically ventilated patients in the ICU. Chest. 1994;106(6):1829–1834. doi: 10.1378/chest.106.6.1829. [PubMed] [CrossRef] [Google Scholar]
12Blaivas M. Transesophageal echocardiography during cardiopulmonary arrest in the emergency department. Resuscitation. 2008;78(2):135–140. doi: 10.1016/j.resuscitation.2008.02.021. [PubMed] [CrossRef] [Google Scholar]
13Comess K, DeRook F, Russell M, et al. The incidence of pulmonary embolism in unexplained sudden cardiac arrest with pulseless electrical activity. Am J Med. 2000;109(5):351–356. doi: 10.1016/S0002-9343(00)00511-8. [PubMed] [CrossRef] [Google Scholar]
14Memtsoudis S, Rosenberger P, Loffler M, et al. The usefulness of transesophageal echocardiography during intraoperative cardiac arrest in noncardiac surgery. Anesth Analg. 2006;102(6):1653–1657. doi: 10.1213/01.ane.0000216412.83790.29. [PubMed] [CrossRef] [Google Scholar]
15van der Wouw M, Poll A, Koster M, et al. Diagnostic accuracy of transesophageal echocardiography during cardiopulmonary resuscitation. J Am Coll Cardiol. 1997;30(3):780–783. doi: 10.1016/S0735-1097(97)00218-0. [PubMed] [CrossRef] [Google Scholar]